rt-PA with Antithrombotic Therapies in a Case with Capsular Warning Syndrome

• Published in: Internal Medicine Vol. 56; no. 4; pp. 441 - 444
• Main Authors: Fuseya, Yasuhiro, Kawamura, Miyuki, Matsuda, Eri, Takada, Kozue, Watanabe, Kiwamu, Fujitake, Junko, Nakaya, Yoshifumi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.01.2017; Japan Science and Technology Agency
• Subjects: Argatroban; Aspirin; branch atheromatous disease; capsular warning syndrome; Case Report; Case reports; Cerebral Infarction - complications; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - drug therapy; Diffusion Magnetic Resonance Imaging; Dysarthria - etiology; Female; Fibrinolytic Agents - therapeutic use; Humans; Internal Capsule - diagnostic imaging; Internal medicine; Ischemia; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - drug therapy; Ischemic Attack, Transient - etiology; Magnetic Resonance Angiography; Magnetic resonance imaging; Male; Paresis; Paresis - etiology; Recombinant Proteins - therapeutic use; Syndrome; t-Plasminogen activator; thrombolysis; Tissue Plasminogen Activator - therapeutic use
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.56.7522

We herein report a case of capsular warning syndrome (CWS) that was successfully treated with recombinant tissue plasminogen activator (rt-PA). A 70-year-old woman had repeated stereotyped transient ischemic attacks (TIAs) of right hemiparesis and dysarthria. After hospitalization, argatroban, aspirin, and cilostazol were started but were ineffective. Thirteen hours after the first episode of TIAs, severe symptoms occurred. Magnetic resonance imaging showed acute infarctions in the internal capsule to corona radiata, so we used rt-PA. Since then, the TIAs have not occurred, and the symptoms have considerably improved. This case suggests that rt-PA might be effective and safe for use in treating CWS.